Relationships between Nurse Staffing and Patient Out comes

護理人力配置與病患結果之相關性

楊克平(Ke-Ping Yang)

《The Journal of Nursing Research》 11卷3期 (2003/09) Pp. 149-158

摘要

許多研究曾顯示護理實務或作業上的改變會影響護理人員與組織結果，然對其顧客，病患結果的影響卻鮮少探究，致未能充份瞭解其間之關係或影響力。本研究之目的在檢視護理人力配置之相關變項，如各護理單位之平均護理時數、護理師與平均病患數之比、工作量與各級護理師之組合比等對病患結果之影響。而病患結果則以跌倒、壓瘡、呼吸道感染、泌尿道感染及病患或家屬之抱怨率等五種負向結果為評量指標。本研究以回溯性 (retrospective) 方式，針對台灣地區某1394 床之醫學中心的21 個內外科住院病患2000 年之護理品質監測記錄、病患記錄、病患分類系統資料及護理人員配置等資料分析。護理人力配置變項與結果變項間之相關性在控制病患嚴重度(patient acuity)後，以多變項分析(multivariate analysis)處理資料。病患嚴重度與護理時數則以病患分類系統電腦資料庫中擷取。研究結果顯示護理人員的工作量是院內感染的最佳預測指標；而平均護理時數則是五項病患負向結果的最好預測因子。此外，N3 佔各級護理師比率較多的單位，其病患之負向結果發生率亦較低。N3或以上層級之護理師人力組合比 (staffing mix) 在維護病患的利益上佔了舉足輕重的角色。本研究結果提供了病患結果 (outcome) 與組織結構 (structure) 有關的實證資料，更突顯了護理人力配置在護理實務品質上的重要性。

關鍵字

護理人力配置 ； 病患結果 ； 病患之負向結果發生率

並列摘要

Nursing studies have shown that nursing care delivery changes affect staff and organizational out comes, but the effects on client out comes have not been studied sufficiently. The purpose of this study was thus to examine the effect of nurse staffing variables- daily aver age hours of care, ratio of RNs to aver age patient census, work load, and skill mix- on patient out comes as measured by five adverse occurrences. The adverse patient occurrences included unit rates of patient falls, pres sure ulcers, respiratory and uri nary tract infections, and patient/family com plaints. Variables were measured retrospectively using consistently avail able data from each month of fiscal year 2000 from 21 med ical-surgical nursing care units in a 1394-bed med i cal cen ter in Tai wan. Data were analyzed by descriptive and multivariate inferentialstatis tics while control ling for patient acu ity level. Results showed that work load of nurses is the most power ful pre dictor of nosocomial infections and hours of care best pre dicted the five adverse patient out come indices. Lower adverse out come rates were more con sistently related to a higher pro portion of N3 level of RNs. Patients could fare better when N3s play a significant role in the staffing mix. The findings pro vide further empirical sup port for the con text of implications that patient out comes are correlated to organizational structure. It obviously illustrates the relation ships between nurse staffing and the quality of nursing practice.

並列關鍵字

nurse staffing ； patient outcomes ； ad verse patient out come occurrences

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